musculoskeletal care

Copyright © 2007, 2004, by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

Musculoskeletal CareMusculoskeletal Care

Chapter 28Chapter 28


Case HistoryCase History

You respond to a call for a man who fell from a roof. You respond to a call for a man who fell from a roof. On arrival, you find the patient screaming in pain. On arrival, you find the patient screaming in pain. You notice lacerations on both legs and bone ends You notice lacerations on both legs and bone ends protruding from one leg. He also has a deformity in protruding from one leg. He also has a deformity in the middle of his left arm.the middle of his left arm.


Skeletal System FunctionSkeletal System Function

Gives the body shape

Protects vital organs

Provides body movement


Bones and Bones and Other Connective TissuesOther Connective Tissues

206 bones

Bones are a form of connective tissue.

Other forms of connective tissue Cartilage Ligaments Tendons


Skeletal SystemSkeletal System


Upper ExtremitiesUpper Extremities


Lower ExtremitiesLower Extremities


Types of JointsTypes of Joints


Types of MusclesTypes of Muscles

Voluntary

Involuntary

Cardiac


Skeletal MusclesSkeletal Muscles


DefinitionsDefinitions FractureFracture

A break in the continuity of bone A break in the continuity of bone

SprainSprain Injury to ligaments, usually resulting from stretching forcesInjury to ligaments, usually resulting from stretching forces

StrainStrain Injury to muscles or their tendons, usually from overstretching or Injury to muscles or their tendons, usually from overstretching or

violent contractionsviolent contractions

DislocationDislocation A displacement of bones in a joint from their normal anatomic A displacement of bones in a joint from their normal anatomic

positionposition


Direct ForceDirect Force


Indirect ForceIndirect Force


Indirect Force – TwistingIndirect Force – Twisting


Average Blood Loss Average Blood Loss with Closed Fracturewith Closed Fracture

Site of FractureSite of Fracture Amount of Blood LossAmount of Blood Loss

Radius or ulnaRadius or ulna 250-500 ml250-500 ml

HumerusHumerus 500-750 ml500-750 ml

PelvisPelvis 1500-3000 ml1500-3000 ml

FemurFemur 1000-2000 ml1000-2000 ml

Tibia and fibulaTibia and fibula 500-1000 ml500-1000 ml


Signs and SymptomsSigns and Symptoms

Pain and tendernessPain and tenderness Deformity or angulationDeformity or angulation Swelling and discolorationSwelling and discoloration Loss of useLoss of use Grating or crepitusGrating or crepitus Exposed boneExposed bone Joint locked into position or dislocationJoint locked into position or dislocation BleedingBleeding


Vascular InjuriesVascular Injuries

Vessels can be compressed or torn.Vessels can be compressed or torn. Dislocations are at high risk for vessel compression Dislocations are at high risk for vessel compression

or injury.or injury. Loss of blood flow to extremityLoss of blood flow to extremity


Vascular Injuries –Vascular Injuries –Signs and SymptomsSigns and Symptoms

Loss of distal pulsesLoss of distal pulses Pale, cool skinPale, cool skin Delayed or absent capillary Delayed or absent capillary

refillrefill PainPain NumbnessNumbness Tingling or pricklingTingling or prickling Sensory lossSensory loss ParalysisParalysis


Vascular Injuries Memory Device –Vascular Injuries Memory Device –The “5 Ps”The “5 Ps”

PPainain

PPallorallor

PPulselessnessulselessness

PParesthesia (tingling)aresthesia (tingling)

PParalysisaralysis


Peripheral Nerve InjuryPeripheral Nerve Injury

Injuries can cause Injuries can cause compression or complete compression or complete tearing of nerve.tearing of nerve.

Violent forces can cause Violent forces can cause direct damage.direct damage.

Nerve injury occurs Nerve injury occurs commonly in joints.commonly in joints.


Signs and SymptomsSigns and Symptoms

Pain and tendernessPain and tenderness Deformity or angulationDeformity or angulation Loss of useLoss of use GratingGrating SwellingSwelling Bruising (discoloration)Bruising (discoloration) Exposed bone endsExposed bone ends Joint locked into positionJoint locked into position


Emergency Medical CareEmergency Medical Care Use personal protection Use personal protection

measures.measures.

Administer oxygen.Administer oxygen.

After life threats have been After life threats have been controlled, splint injuries in controlled, splint injuries in preparation for transport.preparation for transport.

Apply a cold pack.Apply a cold pack.

Elevate the extremity.Elevate the extremity.


SplintingSplinting

ReasonsReasons Prevent motion of bone fragmentsPrevent motion of bone fragments Minimize the following complications:Minimize the following complications:

• Damage to muscles, nerves, or blood vesselsDamage to muscles, nerves, or blood vessels

• Conversion of a closed fracture to an open fractureConversion of a closed fracture to an open fracture

• Restriction of blood flowRestriction of blood flow

• Excessive bleedingExcessive bleeding

• Increased painIncreased pain

• Paralysis of extremities due to a damaged spineParalysis of extremities due to a damaged spine

• Injury to visceraInjury to viscera


General Rules of SplintingGeneral Rules of Splinting

Assess pulse, motor Assess pulse, motor function, and sensation.function, and sensation. Before and after splint Before and after splint

applicationapplication Record findings.Record findings.

Immobilize the joint above Immobilize the joint above and below the injury.and below the injury.



Remove or cut away Remove or cut away clothing.clothing.

Cover open wounds with a Cover open wounds with a sterile dressing.sterile dressing.

Severe deformity, cyanotic Severe deformity, cyanotic distal extremity, or lack of distal extremity, or lack of pulsespulses Align with gentle traction Align with gentle traction

before splinting.before splinting.



Do not intentionally replace Do not intentionally replace the protruding bones.the protruding bones.

Pad each splint to prevent Pad each splint to prevent pressure and discomfort to pressure and discomfort to the patient.the patient.

Splint the patient before Splint the patient before moving when feasible and moving when feasible and no life threats.no life threats.



When in doubt, splint the injury.When in doubt, splint the injury.

If patient has signs of shockIf patient has signs of shock Align in normal anatomic positionAlign in normal anatomic position Transport on backboardTransport on backboard


EquipmentEquipment Rigid splintsRigid splints

Traction splintsTraction splints

Pneumatic splints (air, vacuum)Pneumatic splints (air, vacuum)

Improvised splints, pillowImprovised splints, pillow

Pneumatic antishock garment Pneumatic antishock garment (as a splint)(as a splint)


Hazards of Improper Splinting Hazards of Improper Splinting

Compression of nerves, Compression of nerves, tissues, and blood vesselstissues, and blood vessels

Delay in transport of patient Delay in transport of patient with life-threatening injurywith life-threatening injury


Hazards of Improper Splinting Hazards of Improper Splinting

Splint applied too tightSplint applied too tight

Aggravation of bone or joint Aggravation of bone or joint injuryinjury

Cause or aggravate tissue, Cause or aggravate tissue, nerve, vessel, or muscle nerve, vessel, or muscle damagedamage From excessive bone or From excessive bone or

joint movementjoint movement


Long Bone SplintingLong Bone Splinting Use personal protection measures.Use personal protection measures.

Apply manual stabilization.Apply manual stabilization.

Assess pulse, motor and sensory function before and after splinting.Assess pulse, motor and sensory function before and after splinting.

Severe deformity, cyanotic distal extremity, or lack of pulsesSevere deformity, cyanotic distal extremity, or lack of pulses Align with gentle traction before splinting.Align with gentle traction before splinting.

Apply splint.Apply splint.

Immobilize hand/foot in position of function.Immobilize hand/foot in position of function.


Traction Splinting –Traction Splinting –IndicationsIndications

Mid-thigh injuryMid-thigh injury

No joint or lower leg injuryNo joint or lower leg injury


ContraindicationsContraindications

Injury close to the kneeInjury close to the knee

Injury to the knee Injury to the knee

Injury to the hipInjury to the hip

Injured pelvisInjured pelvis


ContraindicationsContraindications

Partial amputation or Partial amputation or avulsion with bone avulsion with bone separationseparation Distal limb is connected only Distal limb is connected only

by marginal tissue.by marginal tissue. Traction would risk Traction would risk

separation.separation.

Lower leg or ankle injuryLower leg or ankle injury


Traction Splinting –Traction Splinting – Procedure Procedure

Use personal protection Use personal protection measures.measures.

Assess pulse, motor function, Assess pulse, motor function, and sensation before and after and sensation before and after splinting.splinting.

Perform manual stabilization of Perform manual stabilization of the injured leg.the injured leg.

Apply splint.Apply splint.


Traction Splinting –Traction Splinting – Procedure Procedure

Reevaluate proximal/distal Reevaluate proximal/distal securing devices.securing devices.

Reassess pulse, motor and Reassess pulse, motor and sensory function.sensory function.

Secure torso to the long board.Secure torso to the long board.

Secure splint to the long board Secure splint to the long board to prevent movement of splint.to prevent movement of splint.


Specific Splinting Techniques —Specific Splinting Techniques —Upper BodyUpper Body

ClavicleClavicle ShoulderShoulder Upper armUpper arm ElbowElbow Forearm/wristForearm/wrist HandHand PelvisPelvis

Sling and swatheSling and swathe

Sling and swatheSling and swathe

Sling and swathe with splintSling and swathe with splint

Rigid splint/slingRigid splint/sling

Sling and swathe with splintSling and swathe with splint

Rigid splint and slingRigid splint and sling

Long spine board/PASGLong spine board/PASG


Specific Splinting Techniques —Specific Splinting Techniques —Lower BodyLower Body

Dislocated hipDislocated hip Hip injuryHip injury FemurFemur KneeKnee Lower legLower leg Ankle and footAnkle and foot

Anatomic/spine boardAnatomic/spine board

Anatomic/spine boardAnatomic/spine board

Traction splint/PASGTraction splint/PASG

Rigid splintRigid splint

Rigid splintRigid splint

Pillow splintPillow splint

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